Winter A&E data ‘contaminated’, says NHS chief

System leaders have been grappling with the problem of “same day emergency care” admissions being coded as ordinary admissions for some time. NHS emergency care chief Pauline Philip told the NHS England and Improvement joint board meeting the issue may have significantly skewed this winter’s performance data.

Ms Philip was being asked to explain why, despite relatively mild flu and weather conditions, the NHS recorded its worst four-hour performance on record in February.

She told the meeting A&E performance this winter had been “better than last winter”, stating that the NHS had seen 380,000 more patients within four hours this winter than “during the same period last year”.

She said an “explosion” of same day emergency care admissions, particularly over the last 12 months, was encouraging for patients and for clinical practice, but these newer pathways were not being correctly coded.

She added: “We are doing a piece [of] work. I should be able to report on it at the time of the next meeting… to look at the number of admissions and attendances in February because I think what we recognise is that the data is quite contaminated by the transformation that we have put into the system [especially in regards to zero-day admissions].

“We have seen something similar on the attendances side… we can see that some of that attendance increase is because of the new pathways of care we have introduced around type three pathways.”

The most recent quarterly data for performance at consultant-led type one A&E units was the lowest since records started.

The news comes only months after the UK Statistics Authority said in November the NHS had addressed problems it first raised in January 2018.

The problems last winter also surrounded coding issues, although they involved the NHS’ integrity being questioned as well as its counting practices. Hospitals were accused of including statistics from local walk-in centres, even if they were not run by the hospital or on their site, to improve their overall A&E performance.

Urgent cases seen in urgent care centres – so-called type three attendances – are far more easily dealt with inside the four-hour window than the life-threatening or critical cases, type one cases, dealt with in major A&E departments.

The developments also come just weeks after NHS bosses set out controversial plans to ditch the four-hour target, despite concerns removing it could lead to quality standards being watered down.

The NHS’ overall performance against the 95 per cent four hour standard was 84.2 per cent, down from the previous record low of 84.4 per cent in January. The overall target was last hit July 2015.

Performance for major departments – type ones – was 75.7 per cent, which was down on the previous record low of 76.1 per cent in January 2019 and 76.9 per cent for the same month last year.